Treatment of hemorrhoids

Although you will probably only hear the term 'haemorrhoids' if it is a disease that has become symptomatic, i.e. has manifested itself in some way. In fact, they are a normal part of our anatomy. Hemorrhoids are pads of tissue located in the lower part of the rectum that contain blood vessels, muscle and elastic fibers. Hemorrhoids contribute to our resting continence, which means they help the body control the emptying of stool. When you don't experience itching, burning or discomfort caused by hemorrhoids, you probably don't think about them at all, but they are always there. Haemorrhoids are the most common proctological disease and statistics suggest that up to 50 % of patients over the age of 50 have some form of this disease. Nowadays, however, it also affects younger people.

Hemorrhoids are distinguished internal and external.

Internal Hemorrhoids, unless they are in the advanced third or already in the fourth or last stage, they are usually not visible and are located at the end of the anal canal or the beginning of the anus. They are veins under the mucous membrane which, under certain conditions, dilate and enlarge and often begin to come out of the rectum after stool. Consequently, they cause associated difficulties, the most common of which are bleeding, prolapse - running out - up with the necessity of pushing, itching /in advanced stages 3 and 4 of the disease/ so changes in the skin due to chronic irritation.

Soreness at internal haemorrhoids is rare.  When there is pain in the anal canal area, it is always necessary to look for another diagnosis. 

Stages of haemorrhoidal disease

Currently, staging of internal hemorrhoids is used to four degrees of disease severity.

Level 1 haemorrhoid (golden vein) disease

can be solved conservatively /non-surgically/ and painlessly, so do not hesitate to visit a proctologist at the first symptoms associated with this disease. 

Level 2 diseases of hemorrhoids

The second stage diseases of the rectum conservative treatment is already unsuccessful and the disease gradually progresses and symptoms worsen. The haemorrhoid enlarges, it can occasionally protrude from the rectum outwards, but still manages to "absorb" itself inside. Because of the delicacy of this problem, patients often choose self-medication, which unfortunately only alleviates the symptoms but does not solve the problem, which often worsens and develops into the next stage of the disease.

Level 3 diseases of hemorrhoids

The third stage The stage of the disease, which we encounter in our outpatient clinic quite often, is the stage when the protruding hemorrhoid cannot retract back inside by itself and the patient pushes the hemorrhoid inside himself, which can cause swelling or inflammatory complications, which can often manifest themselves in mucus or blood on the patient's underwear.

Level 4 diseases of hemorrhoids

At the fourth stage of the disease, surgical treatment, called haemorrhoidectomy, is indicated in most cases. It requires hospitalization in hospital and subsequent incapacity for work with subsequent convalescence. 

At our proctology centre we provide Outpatient treatment of stage 4 disease.

Don't let your disease reach this stage and visit our proctology centre as soon as possible. Self-treatment leads in most cases to a gradual worsening of the disease and its progression to later stages with the consequent need for a more invasive approach, incapacity for work and socio-economic loss. Even minimal symptoms can be warning signs!

At our proctology center, we have many years of experience in all forms of hemorrhoidal disease treatment.

Treatment options for hemorrhoids

During the initial consultation and initial examination, our doctor will make a diagnosis, assess the condition, determine the exact stage of the disease and suggest treatment according to the latest standards and recommendations. V at our proctology centre we always rely on EBM - Evidence base medicine.

If treatment is necessary, our proctology centre provides treatment of internal haemorrhoids with Barron's ligature, LHP-Laser and sclerotherapy.

Barron's ligature

It is a treatment with a latex rubber band or also "rubberizing". A rubber band is applied to the base and inner haemorrhoidal knot, which prevents the inflow and outflow of blood and therefore oxygen, resulting in its death, falling off with the formation of a scar at the site of the original knot, the haemorrhoid.

It is an elegant, quick, painless method without serious complications, without interference with the integrity of the anal canal or the sphincter apparatus. It is reported that up to 80 % cases can be solved by this method. The patient immediately returns to normal life without significant limitations.

The treatment consists in most cases of a maximum of 4 sessions, is painless and the patient can immediately return to normal life without restrictions and with minimal socio-economic losses. After consultation with a proctologist, in certain cases a solution with fewer sessions may be proposed.

Barron's ligature is mainly intended for the treatment of the 2nd stage of the disease, in indicated cases it can also be used in the 3rd stage of the disease. In strictly individual cases, this method can even be used in stage 4, especially in patients unsuitable for surgical treatment for a specific reason.

External haemorrhoids are usually not a problem in the resting state, but complications can arise and therefore treatment should not be delayed. External haemorrhoids are often hidden behind internal haemorrhoids. Patients often confuse external and internal haemorrhoids and incorrectly identify the problem as internal haemorrhoids. In most cases, they are not a medical problem, but rather an 'aesthetic' and hygienic problem. Exceptions are acute cases, such as the formation of a clot. This is treated painlessly, using radiofrequency with a tissue-friendly method. Without complications and restrictions.

It should be noted that in some cases, after treatment of internal hemorrhoids, external hemorrhoids are often "shrunk" as well.

LHP - Laser Safe and modern procedure

Laser treatment of vascular structures has long been proven in the treatment of varicose veins. In proctology, the treatment of haemorrhoids with the 810 nm laser was first reported in 2009 by Hèlio Plapler of the University Hospital of Sao Paulo. The development of a fine cone-shaped fiber optic probe and the use of a 1470 nm laser with an optimized waveform have improved the efficiency of the laser application. 

Haemorrhoidoplasty (LHP) can now be considered a sophisticated therapeutic procedure. The haemorrhoidal nodes are reduced and fixed from the inside with dosed laser energy. 

The key advantages of Laser treatment of hemorrhoids are:

• The procedure is performed on an outpatient basis.
• LHP can be used in the 2nd, 3rd,but also in the 4th stage of the disease 
• This avoids larger wounds and more excruciating pain than with conventional hemorrhoid removal
• Downtime in work and sports is minimal compared to conventional surgery. 
• Studies have shown greater efficacy and improved quality of life after laser hemorrhoidoplasty 
• The original, physiological tissue of the haemorrhoidal plexus, which is important for elasticity, sensitivity and sealing of the anus against gases and fluids, is preserved and reduced to normal levels
• The sphincter is protected

Our experience shows that laser hemorrhoidoplasty is a very safe and effective procedure, especially when compared to other surgical treatment techniques.

• Bleeding from the laser channels can occur, but is never dangerous and can usually be stopped with gentle pressure.
• Local swelling and perianal thrombosis may occur during the first two weeks, are not uncommon and will resolve on their own.

Very good long-term results can be expected with this type of procedure.

Laser haemorrhoidoplasty (LHP): treatment process - individual treatment steps

Medical history (previous medical history) and local findings

At the first appointment in our outpatient clinic, the doctor will explain the duration, type and intensity of your symptoms. A local examination will clarify whether enlarged hemorrhoids are actually responsible for these symptoms. At least half of all patients with "hemorrhoids" actually suffer from anal fissure or anal eczemawhich is often independent of the rectum.

Discussion of alternatives

Is laser hemorrhoidoplasty the optimal procedure for you and your current findings? In principle, it can treat hemorrhoids at any stage. In the early stages, it is more effective to treat them with even less invasive methods, with the same result as Barron's ligature or sclerotherapy. Conversely, for single, very large nodules, conventional removal of hemorrhoids the method of choice. On the other hand, if the patient has only a few symptoms, it is sometimes possible to dispense with surgery altogether and treat only the symptoms with stool control and local symptomatic treatment. 

Sclerotherapy - Sclerotherapy of haemorrhoids  

It is a non-surgical treatment that aims to stabilize connective tissue.The treatment can be performed painlessly on an outpatient basis. It usually has to be repeated several times at intervals of several weeks. It may take some time until the symptoms disappear completely.

Complications are extremely rare with the small-volume superficial injection technique. Serious tissue damage has been reported with previously used phenol-oil mixtures; the agents used today are low-risk and very well tolerated. If you have inflammatory bowel disease or are pregnant, you should avoid sclerotherapy.